Provider Demographics
NPI:1801899828
Name:NAU, EDGARD (DPM)
Entity type:Individual
Prefix:DR
First Name:EDGARD
Middle Name:
Last Name:NAU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3125
Mailing Address - Country:US
Mailing Address - Phone:212-569-0269
Mailing Address - Fax:212-658-9928
Practice Address - Street 1:4915 BROADWAY
Practice Address - Street 2:SUITE 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3125
Practice Address - Country:US
Practice Address - Phone:212-569-0269
Practice Address - Fax:212-658-9928
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004265213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01371402Medicaid
NYT38760Medicare UPIN
NY01371402Medicaid